title: Pre- and post-operative risk factors associated with cerebrovascular accidents in patients supported by left ventricular assist device. -Single center's experience in japan-.
abstract: BACKGROUND
  Cerebrovascular accident (CVA) is a major adverse event following left ventricular assist device (LVAD) surgery. This study investigates pre- and post-operative factors associated with CVA in this population.
  
  
  RESULTS
  A total of 118 consecutive patients who underwent LVAD surgery at our institution between April 1994 and April 2009 were retrospectively reviewed. Clinical characteristics, hemodynamic data, and laboratory indexes associated with CVA after LVAD surgery were analyzed. In total, 57 (48.3%) patients developed CVA 133.5 ± 184.7 days after surgery. The combination of baseline heart disease, type of LVAD surgery, mean right atrial pressure (mRA), serum total bilirubin and total protein concentration, and right ventricular end-diastolic dimension (RVEDd) was associated with CVA at any time after LVAD surgery, with a discriminant probability of 718%. With regard to CVA development later than 3 months after surgery, the combination of mRA and RVEDd before surgery [odds ratio (OR), 1.24, 1.20; 95% confidential interval (CI), 1.07-1.42, 1.06-1.34; P = 0.004, P = 0.006, respectively], positive blood culture, and C-reactive protein after surgery (OR, 7.66, 2.19; 95%CI, 1.50-39.0, 1.47-3.25; P = 0.015, P < 0.0001, respectively) was associated with CVA with a discriminant probability of 85.9%.
  
  
  CONCLUSIONS
  Patients' general condition including malnutrition, in addition to device selection, contributed to overall CVA development after surgery. In the chronic phase after surgery, pre-LVAD right heart failure and post-LVAD systemic infection were highly associated with CVA development.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Ikutaro
authors.initials: I
authors.lastname: Nakajima
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Komamura
authors.forename: Ayako
authors.initials: A
authors.lastname: Takahashi
authors.forename: Noboru
authors.initials: N
authors.lastname: Oda
authors.forename: Taro
authors.initials: T
authors.lastname: Sasaoka
authors.forename: Masanori
authors.initials: M
authors.lastname: Asakura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hashimura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kitakaze
mesh_terms: D006333:Heart Failure / Q000150:complications; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000150:complications; D007564:Japan; D011184:Postoperative Period; D057234:Preoperative Period; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000601:surgery / Q000628:therapy